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Welcome to Maternity CareUpdate for General Practitioners

April 2013

Amanda MansfieldConsultant Midwife

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Seeing Women – 1st Point of Call

Aims Initial Consultation

– Booked by 12 completed weeks –

Midwife – Full Booking Bloods– 9 weeks – Bookings >12 wks – 01753 634561– Late booking >20 wks– Migrant women without previous full

medical assessment – GP – Recognise and intervene with an

obstetric emergency– Promoting Health and lifestyle– Discussion options in relation to

pregnancy options

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E-Learning http://n3.learning.bmj.com/learning/module-intro/.html?moduleId=10031119

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Booking Assessment

Booking History:- – Low Risk– Intermediate Risk– High Risk

Shared Care – Midwife/GP Consultant Led –

Obstetrician (+other specialties)

Choice of Place of Birth – Which hospital

Choice of Mode of Birth – Which hospital does what?

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Antenatal Care

When Where/Who Assessment

<9 weeks GP - Surgery Confirm Pregnancy/Booking Bloods/BP/BMI/Arrange

USS/Refer to MW

<12 weeks MW – Surgery/Home Book in with Local Maternity Provider

Review blood results and Health & Social Needs

Assessment

12-14 weeks Hospital/USS First Trimester Combined Screening or Dating Scan

16 weeks MW – Surgery/Home BP, Urine, Bloods

20-22 weeks Hospital/USS Anomaly Ultrasound

25 weeks (1st Timers) MW – Surgery/Home BP, Urine, Fetal Assessment –

Palpation/Auscultation

28 weeks (All) MW –Surgery/Home BP, Urine, Fetal Assessment, Offer Bloods

31 weeks (1st timers) MW – Surgery/Home BP, Urine, Fetal Assessment, FU Blood tests

34 weeks (All) MW/GP – Surgery/Home BP Urine, Fetal Assessment,

36 weeks (All) MW/GP – Surgery/Home BP Urine Fetal Assessment, Risk assessment for

Place of Birth

38 weeks (All) MW/GP – Surgery/Home BP Urine Fetal Assessment,

40 weeks (1st timers) MW – Surgery/Home BP Urine Fetal Assessment, Discuss Birth Plan

41 weeks (All) MW – Surgery/Home BP Urine Fetal Assessment, Cervical Assessment

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Referrals

Antenatal Clinic Fetal Assessment Unit ->20 weeks gestation 7-5pm

Monday – Friday– Raised blood pressure – APEC guidelines ( 3 readings above 140/90– +or – proteinuria) – • Diagnosed cholestasis. - Pregnancy itching should only be referred if there are– abnormal Liver function tests. The GP’s will complete a full assessment of these– women and refer if appropriate.– • Diagnosed IUGR– • Postnatal checks for women with babies in SCBU– • Pre- term premature rupture of membranes– • Small pv bleeds ie. Spotting after 20 weeks gestation– • Hyperemesis/dehydration after 20 weeks gestation– • Anti D administration (see antenatal guideline No 24)– • Glucose Tolerance Test – for suspected diabetes (see LW policy chapter 8)– • Pre LSCS clerking (pre op assessment)– • VBAC assessment at 41 weeks– • Betamethasone injections

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